Comment expliquer la baisse du débit de filtration glomérulaire en cas d'hypertension intra-abdominale ?

Intra-abdominal hypertension (IAH) is a frequent and serious condition affecting critical care patients. IAH diagnostic needs intravesical pressure (IVP) measurement which is recommended for monitoring patients presenting IAH risk factors. IVP monitoring is probably insufficient in daily practice. This could be explained by lack of knowledge about IAH physiopathology, which leads to absence of therapeutic target. Acute kidney injury (AKI) is the earliest and most described organ dysfunction associated with IAH. Moreover, AKI gravity seems to correlates with IAH severity. Physiopathological aspects explaining glomerular filtration rate (GFR) decrease with IAH are probably multifactorial and not completely understood. The role of renal venous congestion is essential to explain AKI in IAH. GFR decrease may reflect a “glomerular capillary shunt” due to a decrease of renal plasmatic flow. Monitoring IVP in daily practice in patients presenting risk factors of IAH would improve knowledge about this condition and the associated AKI.